USTA Louisiana District Jr Team Tennis Championships

Player’s Name                                                  Team                                                             Age/Division               

Parent or Guardian Name                                                                  Contact #                                           

Consent & Waiver Form

Consent to Communications:  I understand that by providing my mailing address, email address, telephone number, and fax number, I consent to receive communications sent by or on behalf of the USTA Louisiana,  its member organizations, and their representatives, via email or fax.

Signature of parent/guardian (must be over 18):_______________________________Date: ________

Consent to Publication. I hereby give the USTA Louisiana , its member organizations, and their representatives the irrevocable right to use my name, picture, photograph, or other likeness in all forms and media, and in all manners. This includes but is not limited to print and the web. I waive the right to inspect or approve the finished version (s), including any written copy that may accompany it.

Signature of parent/guardian (must be over 18):______________________________Date: ________

Medical Release: I hereby consent to emergency first aid and other medical procedures, or hospital service that may be rendered by or at accredited hospitals, by appointed physicians, which at the time of injury or illness seem reasonably advisable.

Emergency Contact Information:

Name _________________________________ Home Phone _________________________________

Work Phone ____________________________ Cell Phone ___________________________________

Signature of parent/guardian (must be over 18):________________________________Date: ________

Waiver and Indemnity Agreement: Acceptance of my entry in these events is without responsibility of any kind by the USTA, the USTA Louisiana , the host clubs, committees, or the management of any event in which I may be entered or may participate. In consideration of the acceptance of my entry, I do hereby for and on behalf of myself and my heirs and legal representatives release and forever discharge the USTA Louisiana, the host clubs, their officers, committees, and representatives and their successors and assigns, of and from any and all claims, demands, and injuries, however arising, whether caused by the negligent or intentional acts of the USTA Louisiana and its representatives, representatives of other sponsoring entities, or by third parties, which injuries may be in any way related to my activities during the tournament and any period traveling to or from the events described, and all such claims are hereby waived and released, and I covenant not to sue therefore. The parent or guardian, by signing below, does hereby agree to indemnify and hold harmless the USTA Louisiana and its representatives and the sponsoring entity from any liability which they may incur to the entrant, howsoever arising and whether caused by the negligent or intentional acts of the USTA Louisiana , its representatives, or the sponsoring body. I understand that this tournament will be governed by applicable USTA rules and regulations, the rules and regulations of this tournament, the rules and procedures governing discipline of players in USTA sanctioned tournaments, the USTA code of ethics, tournament policy, and ranking regulations and agree to conduct myself accordingly.

Signature of parent/guardian (must be over 18):________________________________Date: ________

I have read and understand the foregoing releases, waivers and indemnity agreement.

RETURN THIS FORM TO YOUR CAPTAIN

NO PLAYER MAY COMPETE WITHOUT A COMPLETED FORM